A novel, easier and safer alternative method for oesophagojejunal reconstruction after totally laparoscopic total gastrectomy.

BACKGROUND: This study presents a novel laparoscopic modified overlapping oesophagojejunostomy anastomosis method which consists of self-pulling and latter transection to perform a safer anastomosis, describes the anastomosis technique in detail and reveals its short-term outcomes. METHODS: Forty-five patients underwent totally laparoscopic total gastrectomy using the self-pulling and oesophagus latter-cut overlap method anastomosis for gastric cancer from January 2019-2022. During the self-pulling phase, the oesophagus was ligated at the level of the gastroesophageal junction or above and dragged down by a ligature rope to mobilise up to 5-6 cm. An entry hole was created on the right side of the oesophagus, and a nasogastric tube was taken out through the hole and tip of the tube was used as a guide for the endoscopic linear stapler to decrease the risk of entering the false lumen and creating a side-to-side anastomosis. The oesophagus was then latter-transected by a second endoscopic linear stapler. The common entry hole was closed using a hand-sewing method. Clinicopathological characteristics and surgical outcomes were collected and retrospectively evaluated. RESULTS: The mean anastomosis duration was 27 min. The morbidity rate was 4.4%. Only two patients experienced postoperative complications but subsequently recovered conservatively. None of the patients suffered anastomotic leak or stricture. CONCLUSIONS: Self-pulling and latter transection-based overlapping anastomosis is a simple and reliable approach that overcomes most of the limitations of standard overlap method and provides satisfactory surgical outcomes.

Early results of single-incision laparoscopic cholecystectomy in comparison with the conventional: Does it have any impact on quality of life?

BACKGROUND: Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases. In recent times, single-incision laparoscopic cholecystectomy(SILC) has developed as a less invasive alternative technique to conventional laparoscopy. In the literature, many studies have compared SILC and conventional laparoscopic cholecystectomy (CLC) procedures but a limited number of studies have compared the two techniques with regard to quality of life (QOL). The choice of surgical procedure was effected by QOL of the patients. The effects of SILC on QOL remain unclear. In this study, we aimed to compare the effects of conventional laparoscopic cholecystectomy (CLC) and single-incision laparoscopic cholecystectomy (SILC) procedures on the clinical outcomes and quality of life of patients by short-term follow-up evaluation. MATERIAL AND METHODS: In this study, 142 patients who underwent cholecystectomy operations with either technique underwent SILC and CLC were evaluated. The quality of life index in the patients was measured with short form 36 (SF 36) test. RESULTS: The results of mean operative time, length of stay and complication rate for SILC and CLC were similar. The postoperative health-related quality of life (HRQOL) scores were not significantly different between the SILC and CLC patients but only physical functioning score were higher in SILC patients. CONCLUSIONS: SILC is a safe and effective alternative to CLC. To detect the effects of SILC on HRQOL, we need long-term prospective comparative studies.

Giant Cutaneous Leiomyosarcoma Originating From the Abdominal Wall: A Case Report.

BACKGROUND: Leiomyosarcoma, a rare type of tumor, accounts for 5-10% of all soft tissue tumors. CASE REPORT: A 44-year-old male patient was admitted to the emergency service of our medical faculty with the complaints of fatigue and abdominal mass. CONCLUSIONS: The pathology result was leiomyosarcoma. Leiomyosarcoma of the skin is rare and our case is the largest such lesion reported in the literature.

Cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treatment of peritoneal carcinomatosis: Our initial experience and technical details.

OBJECTIVE: The aim of this study is to present our initial experience in peritoneal carcinomatosis treatment and the technical details of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the light of current literature. MATERIAL AND METHODS: Data of 27 consecutive patients who were treated with CRS and HIPEC for peritoneal carcinomatosis in Medical Park Samsun Hospital, between November 2012 and September 2014 were retrospectively reviewed. Treatment indication and management were evaluated at the multidisciplinary oncology council. All patients underwent CRS and HIPEC with the aim of complete cytoreduction. Patients with unresectable disease and/or palliative surgery were excluded from analysis. Perioperative complications were classified according to Clavien-Dindo classification, and HIPEC-related side effects were identified using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) criteria. Demographic, clinical and histopathological data of the patients were analyzed. RESULTS: The mean age was 54 (32-72). Nineteen patients were female. The origin of peritoneal carcinomatosis was colorectal cancer in 12 patients, ovarian cancer in 12 patients, gastric cancer in 2 patients and pseudomyxoma peritonei in 1 patient. The mean Peritoneal Carcinomatosis Index was 12 (3-32), with a mean operative time of 420 (300-660) minutes. Perioperative morbidity, HIPEC-related toxicity and perioperative mortality were observed in eight (30%), one (3.7%) and four patients (14.8%), respectively. During a mean follow up of 13 (1-22) months, overall and disease-free survival rates were 95.8% and 82.6%, respectively. Two patients with colorectal cancer (after 9 and 12 months) and one patient with ovarian cancer (after 11 months) had intra-abdominal recurrence. One patient with ovarian cancer had liver metastases 13 months after surgery, and underwent resection of segments 6-7. The remaining patients are being followed-up without any recurrence. CONCLUSION: Cytoreductive surgery and HIPEC have favorable results in the treatment of patients with peritoneal carcinomatosis. Compatible with the literature, surgical outcomes of the presented series are encouraging for this treatment modality that have been recently popularized in our country. Careful perioperative evaluation, proper patient selection and multidisciplinary approach are essential for success in curative treatment of peritoneal carcinomatosis.

Factors affecting survival in patients who underwent pancreaticoduodenectomy for periampullary cancers.

OBJECTIVE: The purpose of this study was to determine the factors affecting survival in patients who underwent pancreaticoduodenectomy for periampullary cancers and to discuss the outcomes of our findings. MATERIAL AND METHODS: This retrospective study included 79 patients who underwent pancreaticoduodenectomy for periampullary cancers between September 1987 and October 2011 in the Department of General Surgery at Ondokuz Mayis University School of Medicine. The factors of age, tumor localization, tumor size, lymphovascular invasion, status of lymph node metastasis, tumor differentiation, preoperative CA 19-9 levels, preoperative total bilirubin levels, preoperative albumin levels, and preoperative biliary drainage were investigated to determine their influence on survival. The survival periods were calculated using the Kaplan-Meier method. The log-rank test was used for comparison of the prognostic factors. The independent prognostic factors affecting survival were determined by Cox hazard regression analysis and hazard ratios (HR) and 95% confidence intervals (CI) were calculated. P<0.05 was considered as significant. RESULTS: The following were identified as independent prognostic factors adversely affecting survival: tumor size ≥2 cm (HR: 2.0, 95% CI: 0.27-0.90), lymphovascular invasion (HR: 2.9, 95% CI: 0.18-0.60), CA 19-9 levels ≥100 U/mL (HR: 2.0, 95% CI: 0.26-0.90), and albumin levels <2.5 mg/dL (HR: 2.7, 95% CI: 1.14-6.66). CONCLUSION: The independent prognostic factors identified in this study can be used for selection of patients for whom pancreaticoduodenectomy should be applied for periampullary cancers. These factors could help us to estimate survival rates.

Changes in the frequencies of abdominal wall hernias and the preferences for their repair: a multicenter national study from Turkey.

Abdominal wall hernias are a common problem in the general population. A Western estimate reveals that the lifetime risk of developing a hernia is about 2%. As a result, hernia repairs likely comprise the most frequent general surgery operations. More than 20 million hernias are estimated to be repaired every year around the world. Numerous repair techniques have been described to date however tension-free mesh repairs are widely used today because of their low hernia recurrence rates. Nevertheless, there are some ongoing debates regarding the ideal approach (open or laparoscopic), the ideal anesthesia (general, local, or regional), and the ideal mesh (standard polypropylene or newer meshes).

Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?

BACKGROUND: We aimed to investigate the results of a non-operative approach to blunt spleen injury to re-evaluate the importance of injury grade. METHODS: Thirty-one blunt splenic trauma cases subjected to non-operative treatment were evaluated retrospectively. The patients were classified into two groups as isolated spleen trauma (ST) group and multi-trauma (MT) group. The hospitalization and blood replacement needs, success of non-operative follow-up, and post-traumatic complications were compared between the two groups. The patients were evaluated via follow-up abdominal ultrasonography (US) and computerized tomography (CT). The results were evaluated with regard to post-splenic trauma complications. RESULTS: According to the organ injury scale of the American Association for the Surgery of Trauma, 25.8% were grade-1, 32.2% grade-2, 29% grade-3, and 12.9% grade-4 injuries. It was observed that the transfusion amount was directly proportional to the injury grade. All patients with grade-4 injury and 14 patients with MT were treated successfully with the non-operative method. Splenic pseudoaneurysm developed in one patient in the MT group. One patient was diagnosed with late splenic rupture. CONCLUSION: Hemodynamic stability is the most important criterion for the indication of non-operative treatment. However, in well-selected cases, patients with grade 4 splenic traumas and those with extra-splenic injuries could also be treated successfully with the non-operative method.

Spleen-preserving laparoscopic distal pancreatectomy: Two cases and review of the technique.

In this study, we aimed to assess the technique and results of spleen-preserving laparoscopic distal pancreatectomy (SPLDP) on the basis of two cases. The first case was a woman with a large cystic papillary lesion of the distal pancreas. The other patient was a woman with a pancreatic mass on the tail of the pancreas. Both patients were operated on using SPLDP. Five trocars were used in the first case and four trocars were used in the second case. Thirty degree telescope visualization and LigaSure dissection were used during the operation. The splenic vessels were dissected, but the short gastric vessels were preserved. The pancreas was transected by one Endo GIA stapler and the cut edge of the pancreas was reinforced with sutures to prevent a pancreatic fistula. We performed the same technique in both cases. However, in the first case, we aspirated the content of the cystic mass of the pancreas before removing it to avoid making a large incision. The duration of the operation was 190 and 135 minutes, respectively. There were no postoperative complications. SPLDP is a safe, effective modality for managing lesions of the distal pancreas. If the splenic vessels are transected, the short gastric vessels must be protected to ensure the viability of the spleen.

Single-incision laparoscopic cholecystectomy in a 6-month pregnant woman: a report of a case.

AIM: We aimed to present a case of single-incision laparoscopic cholecystectomy (SILC) in a pregnant woman. CASE: A 27-year-old, 24-week pregnant woman was referred to our clinic with abdominal pain, nausea, and vomiting. Physical examination and laboratory tests showed that she had acute biliary pancreatitis. An obstetric consultation showed that the patient and the fetus were healthy. After medical treatment the patient was discharged. However, she was again referred to our clinic with a second pancreatitis attack. We examined the patient and recommended cholecystectomy. Preoperative tests were completed and a new obstetric consultation was requested. After the receipt of informed consent for cholecystectomy, SILC was performed. CONCLUSIONS: SILC is a feasible surgical method in pregnant women as well.

Is oval flap reconstruction a good modification for treating pilonidal sinuses?

BACKGROUND: Flap techniques are acceptable for the surgical treatment of pilonidal sinuses. This study assessed a new modification of the rhomboid flap technique. METHODS: The study included 133 patients with pilonidal disease who were treated between April 2004 and April 2009. The pilonidal sinus was removed with an oval excision, and an oval head rhomboid flap was prepared to reduce flap necrosis. RESULTS: The mean age of the patients was 27.4 ± 4.6 years (range, 13-80). The rate of minor postoperative complications was 11.3%. The mean hospital stay was 2.3 ± .8 days (range, 1-6). The rate of recurrence was 1.5%. Regarding cosmetic results, 116 (87%) patients were very pleased, 15 (11.2%) were pleased, and 5 (3%) were displeased. The mean follow-up period was 22.5 ± 12.4 months (range, 5-57). CONCLUSIONS: The oval flap reconstruction method is a recommended procedure that produces fewer ischemic flaps with a low rate of recurrence and acceptable cosmesis.

Comparative evaluation of adhesions to intraperitoneally placed fixation materials: a laparoscopic study in rats: adhesions to fixation materials.

After laparoscopic ventral hernia repair, the nature of the adhesions to fixation materials or to mesh had not been clarified. We examined adhesion formation specific to the fixation material in rats. We designed an experimental laparoscopy setup, and placed four intraperitoneal fixation materials on the peritoneum of rats without a mesh graft. Another group of researchers documented the incidence and intensity of postoperative adhesion formation. The adhesion scores for the nickel-titanium anchor were significantly greater than those for polylactic acid (p = 0.004), a titanium tacker (p < 0.0001), and fibrin glue (p < 0.0001). No adhesions occurred in the fibrin glue group. Fibrin glue is the preferred fixation material because it produced no postoperative adhesions. The nickel-titanium anchor produced heavy adhesions but may be applicable for recurrent hernia cases and in patients with thin abdominal walls.

[Non-operative management of blunt hepatic trauma]. / Künt karaciger travmalarina konservatif yaklasim.

BACKGROUND: Blunt hepatic trauma is frequently seen, particularly as a result of traffic accidents. Given that surgical therapy may have high rates of morbidity and mortality, a selected group of patients may can benefit from conservative management. We herein present, a group of patients with blunt hepatic trauma who were managed without any invasive diagnostic tools and / or surgical intervention. METHODS: Nineteen hemodynamically stable patients (9 males, 10 females; mean age 46,6; range 19-73 years) with blunt hepatic trauma were included in the study. Vital signs, hemodynamic parameters, liver function tests, need for transfusion, hospital stay and results of radiological tests were recorded as well as demographic characteristics. Classification of injury was done according to the American Association for the Surgery of Trauma's Organ Injury Scaling System. RESULTS: Nineteen patients had radiologically-proven liver injury. Nine patients had grade I injury, five had grade II, two had grade II and three had grade IV injuries. Twelve patients required blood transfusions. Fourteen patients had mild elevation of transaminases while the remaining five were completely normal. Mean hospital stay was 7.6 days. Blunt trauma was associated with a large abdominal wall hernia in one patient; the defect was repaired laparoscopically three months later. No patient underwent surgery due to the failure of conservative management and there was no death. CONCLUSION: For blunt hepatic trauma patients, non-operative management may be the initial therapy if haemodynamic stability can be maintained. The decision for surgical intervention should be given according to the presence of associated intraabdominal injuries. Liver injury score of patients is not as important as the hemodynamic status for determining conservative management.

Atrial septal defect and retrosternal toxic goitre operated in the same session: a case report.

In this study, we present a 55-year-old female patient who suffered from atrial septal defect (ASD) and retrosternal toxic goitre simultaneously. The patient had been treated with a 300 mg/day dose of propylthiouracil for 20 days prior to operation. This patient has been operated on for both disorders and has recovered.

Santulli enterostomy revisited: indications in adults.

BACKGROUND: Surgical patients frequently need some type of intestinal stomas for a wide spectrum of disorders. Maintaining effective and enough decompression of gastrointestinal tract, securing distal bowel segments and anastomosis are the primary goals of ostomy formation as well as providing a minimum complication rate of closure or "take-down". METHOD: In this report, we present five adult patients who were operated for some kind of intestinal disease and required enterostomy. We preferred Santulli type of enterostomy which was formerly used by pediatric surgeons. In this technique, the proximal afferent bowel is fashioned into a stoma and anastomosed side-to-end with double layer sutures into the distal efferent bowel. RESULT: One of the five patients died of systemic problems, other four did well in terms of surgical outcome of the stoma. CONCLUSION: We concluded that; although indications are limited, Santulli enterostomy can be performed in adult patients as effective as pediatric age group, particularly for its advantages in early restoration of intestinal continuity and diminished risk for post-closure complications.

Endoscopy-assisted resection for multiple polyps of the small intestine in Peutz-Jeghers syndrome: a father and daughter story.

Peutz-Jeghers syndrome is an infrequently encountered disease with potential complications including bleeding, intestinal obstruction, intussusception, and malignant transformation. We report on two patients, father and daughter, with Peutz-Jeghers syndrome who were admitted to hospital with similar complaints of abdominal pain. The father was 37 years old and the daughter was 17. Physical examination and laboratory tests revealed small intestinal intussusception in both patients. In the daughter, the intussuscepted segment was resected. An electrosurgical snare was also used for enteroscopic excision of multiple jejunal and ileal polyps. In the father, two 4-cm polyps were surgically resected while an enteroscopic surgical snare was used for polyps of smaller size. Both patients were discharged on postoperative day 7.

Laparoscopic bilateral hernia repair using fibrin sealant: technical report of two cases.

Minimally invasive surgery is widely used in hernia repair given its advantages such as minimal disturbance to the surrounding tissues, shorter hospital stay, and promising long-term results. Efforts are still being made to make this minimally invasive procedure even more minimal. New tissue adhesives avoid the use of foreign materials and the postoperative pain that might be attributed to staples. We present the first two cases of bilateral inguinal hernia repair performed with a totally extraperitoneal procedure using fibrin sealant instead of staples for the fixation of the mesh.

Surgical management of enoxaparin- and/or warfarin-induced massive retroperitoneal bleeding: report of a case and review of the literature.

A 70-year-old man on enoxaparin and warfarin sodium therapy due to pulmonary embolism was admitted for evaluation of a sudden, sharp pain in the left inguinal region. Physical examination revealed a 5 x 10 cm tender mass. Abdominal ultrasound showed a 9 x 9 x 10 cm left retroperitoneal hematoma. INR was 2.1, and anticoagulation therapy was discontinued. A regimen of supportive therapy (vitamin K, fresh frozen plasma and blood transfusion) was started, but the hemorrhage continued to enlarge, up to 9 x 10 x 20 cm, and the patient experienced a significant deterioration in his overall status. He underwent an urgent laparotomy and the hematoma was evacuated. A retroperitoneal abscess developed during the postoperative period which was drained percutaneously. He was discharged on postoperative day 33 with no further complaints. This case demonstrates the importance of surgical therapy in the treatment of spontaneous retroperitoneal hemorrhage caused by anticoagulant therapy.

Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases.

PURPOSE: In the past, various methods of surgical or nonsurgical treatment of sacrococcygeal pilonidal sinus have been used. The most common problem in the treatment of this disease is recurrence. In the present study, our aim was to determine the long-term results of the Limberg flap procedure. METHODS: We present 200 consecutive patients with pilonidal sinus who underwent the Limberg flap procedure between 1992 and 2001. Twenty-six (13 percent) of the 200 patients were operated on because of recurrent pilonidal sinus. Under general or local anesthesia, all sinus tracts were resected en bloc, and the Limberg flap was prepared from the gluteal region. We used a suction drain. We met all patients and recorded their complaints and complications of treatment. RESULTS: Five sinuses recurred (2.5 percent). Minimal flap necrosis occurred in only six patients (3 percent). In three patients (1.5 percent), seroma developed. Wound infection occurred in three patients (1.5 percent). The mean hospital stay was 3.1 days, whereas the mean time to return to work was 12.8 days. CONCLUSION: The Limberg flap procedure is a good treatment choice for pilonidal sinus because of its low complication rate, the short time to return to normal activity, and good long-term results. This procedure has good postoperative results and is a comfortable surgical method for the patient.